This application responds to AHRQ FOA PAR-09-071. We propose to implement improvements in a regional health-information exchange (HIE) designed to enable clinicians who manage transitions of care, to work more effectively and efficiently and to utilize the HIE more fully. The Keystone Health Information ExchangeTM (KeyHIETM), created with support from AHRQ Implementation Grant UC1HS016162, enables 8 hospitals and emergency departments and 38 ambulatory clinics in 31 counties of central and northeastern Pennsylvania to exchange test results and clinical summaries. KeyHIE contains administrative information for a population of 2.6 million over 1 million visits and 40,000 hospital discharges annually. Patients who authorize the sharing of their records (as 300,000 have already), will enable the clinicians caring for them to view their clinical information from across the region. KeyHIE uses technology and standards published by the Health Information Technology Standards Panel (HITSP), and will become part of the National Health Information Network (NHIN) when it is implemented. The proposed project, the next phase of KeyHIE's development, is designed to support safer, more effective transitions of care. To achieve this, we will add critical transitions-of-care clinicians as exchange users-case managers, home-health nurses, emergency responders, and long-term care facility clinicians. We will also expand the exchange's clinical content by adding additional laboratory and radiology reports;medication lists from pharmacy benefit management companies (PBMs) and retail pharmacies;and problem lists, allergy lists, electrocardiogram (ECG) traces, and consult reports. Finally, we will automate the distribution of patient information from participants'EHRs to KeyHIE and from KeyHIE to the EHRs of other participants who care for the patient. We will test the hypothesis that when KeyHIE contains more comprehensive clinical information, use of the exchange will increase, care will become more efficient and of higher quality, and patient outcomes will improve. Using de-identified data, we will monitor the use of the exchange over five years. We will conduct baseline and follow-up surveys with clinicians to understand their motivations for using the exchange, and with clinicians and patients to understand their perceptions of the exchange's usefulness. We will collect detailed data from a subset of high-use clinicians about whether and how their diagnostic and care plans are (or would be) affected by information available in the exchange and how their patients'outcomes change with exchange use. Finally, we will conduct a pre/post sub-study of care efficiency at selected provider facilities. PUBLIC HEALTH RELEVANCE: Project Narrative - This project will study whether and how the addition of specific types of clinician users and clinical information to a regional health-information exchange increases acceptance and use of the exchange, improves care-process quality and efficiency, and improves patient outcomes.